近距离组织间插植放疗治疗局部复发转移晚期妇科肿瘤效果观察

Efficacy observation of interstitial brachytherapy in locally recurrent and metastatic advanced gynecologic cancer

目的评估组织间插植放疗治疗局部复发转移晚期妇科肿瘤的效果及安全性。方法回顾性分析2020年6月至2021年7月山西省肿瘤医院收治的接受徒手近距离插植放疗的局部复发转移晚期妇科肿瘤患者临床资料。比较依据病灶大小、部位、复发前无进展生存(PFS)等情况分组的患者间客观缓解率(ORR)。采用Kaplan-Meier法单因素分析复发后PFS,组间比较行log-rank(Mantal-Cox)检验。采用多因素Cox比例风险模型分析复发后PFS影响因素。总结急性及晚期放射损伤发生情况。结果共20例患者入组,全组ORR为80%(16/20)。亚组分析显示,复发转移病灶长径<4 cm的13例患者均客观缓解,≥4 cm的7例患者中3例客观缓解,两组间ORR差异有统计学意义(P=0.007);阴道内复发转移的13例患者均客观缓解,阴道外复发转移的7例患者中3例客观缓解,两组间ORR差异有统计学意义(P=0.007)。复发前PFS时间<6个月的6例中的3例和≥6个月的14例中的13例均客观缓解,两组间ORR差异无统计学意义(P=0.061)。中位随访6个月(1~13个月)。至随访结束,9例(45%)患者进展。单因素生存分析显示,复发转移病灶长径<4 cm(≥4 cm比<4 cm:HR=4.192,95%CI 0.992~17.710,P=0.029)、复发前PFS时间≥6个月(≥6个月比<6个月:HR=0.163,95%CI 0.038~0.696,P=0.004)、放疗剂量≥15 Gy(≥15 Gy比<15 Gy:HR=0.207,95%CI 0.049~0.881,P=0.016)者复发后PFS较好,但多因素Cox回归分析结果显示上述因素均不是复发后PFS的独立影响因素(均P>0.05)。20例患者均未出现3级及以上直肠、膀胱放射损伤。结论组织间插植放疗治疗局部复发转移晚期妇科肿瘤效果明确,且安全性好。

Objective To evaluate the efficacy and safety of interstitial brachytherapy for locally recurrent and metastatic advanced gynecologic tumors.Methods The data of patients with local recurrence and metastasis of advanced gynecological tumors who underwent brachytherapy in Shanxi Province Cancer Hospital from June 2020 to July 2021 were retrospectively analyzed.Objective remission rate(ORR)was compared among patients grouped according to the size,location of the lesion,and progression-free survival(PFS)before recurrence.Kaplan-Meier method was used to analyze the PFS after recurrence and group comparison was performed by using log-rank(Mantal-Cox)test.Multivariate Cox proportional hazard model was used to analyze the influencing factors of PFS after recurrence.The acute and advanced radiation injuries were also summarized.Results A total of 20 patients were enrolled and the whole ORR was 80%(16/20).Subgroup analysis showed that 13 patients with focal length<4 cm had objective remission,and 3 patients with focal length≥4 cm had objective remission;the difference in ORR between the two groups was statistically significant(P=0.007).And 3 cases out of 6 cases with PFS time less than 6 months before recurrence and 13 cases out of 14 cases with PFS time equal to or more than 6 months before recurrence all had objective remission,and the difference was statistically significant(P=0.061).The median follow-up time was 6 months(1-13 months).By the end of follow-up,9 patients(45%)had disease progression.Univariate survival analysis showed that patients with focal length<4 cm(≥4 cm vs.<4 cm:HR=4.192,95%CI 0.992-17.710,P=0.029),PFS time before recurrence≥6 months(≥6 months vs.<6 months:HR=0.163,95%CI 0.038-0.696,P=0.004),and radiation dose≥15 Gy(≥15 Gy vs.<15 Gy:HR=0.207,95%CI 0.049-0.881,P=0.016)had better PFS after recurrence,but multivariate Cox regression analysis showed that the above factors were not independent factors of PFS after recurrence(all P>0.05).None of 20 patients had radiation injury of rectum and bladder above grade 3.Conclusion The therapeutic effect of interstitial brachytherapy for local recurrence and metastasis of advanced gynecological tumors is clear and safe.